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Spontaneous intracranial hypotension and single entry multi-site epidural blood patch.

Murphy D, Chandna A, Laing A, MacFarlane M - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: Multiple entries to the spinal epidural space, in an effort to alleviate symptoms, are therefore sometimes necessary.These procedures are based on that first published by Ohtonari et al. in 2012.It is, to our knowledge, the first undertaken in Australasia.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Christchurch Public Hospital, Christchurch, New Zealand.

ABSTRACT
The syndrome of spontaneous intracranial hypotension is often difficult to treat. Unfortunately, cerebrospinal fluid leaks are often numerous and difficult to detect radiologically. Multiple entries to the spinal epidural space, in an effort to alleviate symptoms, are therefore sometimes necessary. This case report details two patients treated successfully with a single lumbar entry point and the administration of a continuous multi-site epidural blood patch via a mobile catheter and their subsequent follow-up. These procedures are based on that first published by Ohtonari et al. in 2012. It is, to our knowledge, the first undertaken in Australasia.

No MeSH data available.


Related in: MedlinePlus

Advancement of Progeat micro-catheter to cervical region
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Figure 1: Advancement of Progeat micro-catheter to cervical region

Mentions: Informed consent was obtained from both patients who underwent the procedure on an angiography table with single-plane fluoroscopy. Patient A was positioned prone. Patient B was initially positioned in the lateral position right side up. Local anesthetic (1% lignocaine) was administered and then an extradural puncture, using the paramedian approach, was performed with an 18-guage Touhy needle at L2/L3 in the interlaminar window on patient A and at L4/L5 on patient B. A guide wire (150 cm Bentson Starter guide wire, Boston Scientific) was then advanced into the epidural space with removal of the Tuohy needle and placement of a four French introducer sheath (10 cm Radiofocus introducer II, Terumo Co.). A 4 French catheter (150 cm Radiofocus Guidewire M, Terumo Co.) was initially advanced to T5/T6 for patient A, but could not be advanced further so a 2.7 French micro catheter (130 cm Progeat micro-catheter, Terumo Co.) was used and advanced to the C3/C4 disc level [Figure 1]. For patient B the 2.7 French micro-catheter was solely used and advanced cranially to C5/C6. A volume of 2 ml of Visipaque 270 was used to identify the catheter position. At this stage, approximately 2 ml of autologous blood was introduced at each segmental level as the catheter was withdrawn. This was obtained from each patient from a previously secured, sterile venepuncture in their forearm. Patient A received 50 ml extending from C4/C5 to L1/L2. Patient B received a total of 41.5 ml extending from C5/C6 to L1/L2. Patient A experienced slight back discomfort and right leg pain with the passage of the guide wires in the cephalad direction. She also experienced discomfort when the blood was injected in the thoracic region only. Patient B experienced moderately intense cervical discomfort with the introduction of the blood. Both patients’ symptoms settled with simple analgesia in the recovery room. Patient A was instructed to remain on bed rest for 24 h. Patient B remained on bed rest for 48 h with graded ambulation over the next 24 h. Both patients were discharged 3 days postprocedure with no complications evident.


Spontaneous intracranial hypotension and single entry multi-site epidural blood patch.

Murphy D, Chandna A, Laing A, MacFarlane M - Asian J Neurosurg (2015 Jul-Sep)

Advancement of Progeat micro-catheter to cervical region
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553750&req=5

Figure 1: Advancement of Progeat micro-catheter to cervical region
Mentions: Informed consent was obtained from both patients who underwent the procedure on an angiography table with single-plane fluoroscopy. Patient A was positioned prone. Patient B was initially positioned in the lateral position right side up. Local anesthetic (1% lignocaine) was administered and then an extradural puncture, using the paramedian approach, was performed with an 18-guage Touhy needle at L2/L3 in the interlaminar window on patient A and at L4/L5 on patient B. A guide wire (150 cm Bentson Starter guide wire, Boston Scientific) was then advanced into the epidural space with removal of the Tuohy needle and placement of a four French introducer sheath (10 cm Radiofocus introducer II, Terumo Co.). A 4 French catheter (150 cm Radiofocus Guidewire M, Terumo Co.) was initially advanced to T5/T6 for patient A, but could not be advanced further so a 2.7 French micro catheter (130 cm Progeat micro-catheter, Terumo Co.) was used and advanced to the C3/C4 disc level [Figure 1]. For patient B the 2.7 French micro-catheter was solely used and advanced cranially to C5/C6. A volume of 2 ml of Visipaque 270 was used to identify the catheter position. At this stage, approximately 2 ml of autologous blood was introduced at each segmental level as the catheter was withdrawn. This was obtained from each patient from a previously secured, sterile venepuncture in their forearm. Patient A received 50 ml extending from C4/C5 to L1/L2. Patient B received a total of 41.5 ml extending from C5/C6 to L1/L2. Patient A experienced slight back discomfort and right leg pain with the passage of the guide wires in the cephalad direction. She also experienced discomfort when the blood was injected in the thoracic region only. Patient B experienced moderately intense cervical discomfort with the introduction of the blood. Both patients’ symptoms settled with simple analgesia in the recovery room. Patient A was instructed to remain on bed rest for 24 h. Patient B remained on bed rest for 48 h with graded ambulation over the next 24 h. Both patients were discharged 3 days postprocedure with no complications evident.

Bottom Line: Multiple entries to the spinal epidural space, in an effort to alleviate symptoms, are therefore sometimes necessary.These procedures are based on that first published by Ohtonari et al. in 2012.It is, to our knowledge, the first undertaken in Australasia.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Christchurch Public Hospital, Christchurch, New Zealand.

ABSTRACT
The syndrome of spontaneous intracranial hypotension is often difficult to treat. Unfortunately, cerebrospinal fluid leaks are often numerous and difficult to detect radiologically. Multiple entries to the spinal epidural space, in an effort to alleviate symptoms, are therefore sometimes necessary. This case report details two patients treated successfully with a single lumbar entry point and the administration of a continuous multi-site epidural blood patch via a mobile catheter and their subsequent follow-up. These procedures are based on that first published by Ohtonari et al. in 2012. It is, to our knowledge, the first undertaken in Australasia.

No MeSH data available.


Related in: MedlinePlus